The Correlations of Clinical Outcomes and Vascular Morphology With Infarct Patterns in Middle Cerebral Arterial Occlusion

ABSTRACT Objective To compare the clinical outcomes among various infarct patterns and to investigate the associations between the morphological parameters of contralateral middle cerebral artery (cMCA) M 1 segment and infarct patterns in ischemic stroke attributed to large vessel occlusion (LVO) in M 1 segment caused by intracranial atherosclerotic disease (ICAD). Methods Patients with stroke attributed to M 1 ‐ICAD‐LVO were enrolled. The infarct patterns were categorized into artery‐to‐artery embolism (AAE), large infarct, borderzone infarct (BZI), and perforating artery infarction (PAI). The morphological parameters of cMCA‐M 1 segment included proximal and distal diameter, arc, and chord length. The tortuosity index of cMCA‐M 1 segment was calculated by (arc length/chord length − 1) × 100%. Results A total of 171 participants were enrolled. Compared to AAE, the risk of poor outcome increased in BZI (odds ratio [OR] = 5.51, 95% confidence interval [CI] = 1.71–17.78, p = 0.004) and large infarct (OR = 10.92, 95% CI = 2.01–59.27, p = 0.006) and was comparable in PAI. The tortuosity index (OR = 2.85, 95% CI = 1.13–7.18, p = 0.026) and arc length (OR = 2.47, 95% CI = 1.02–5.97, p = 0.045) significantly increased in BZI than other three patterns. Participants other than BZI were categorized into large infarct ( n = 32) and non‐large‐infarct ( n = 46) groups, and the proximal diameter (OR = 0.22, 95% CI = 0.07–0.72, p = 0.012), arc length (OR = 0.88, 95% CI = 0.78–0.98, p = 0.018), and chord length (OR = 0.87, 95% CI = 0.77–0.995, p = 0.042) were associated with large infarct. Conclusion For patients with M 1 ‐ICAD‐LVO, large infarct and BZI had poorer outcomes than PAI and AAE. The cMCA‐M 1 segment with elevated tortuosity and arc length was associated with BZI, whereas a thin and short M 1 segment was correlated with large infarct in patients with a less tortuous cMCA trunk.